Endocrine Abstracts (2003) 6 DS6

Diabetes amp Hypertension: Causes, Investigations and Management

PM Dodson

Department of Diabetes, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK

The last ten years of research and clinical trials has emphasised the association between diabetes and hypertension. In type II diabetes >70% have associated hypertension according to criteria of >140/80 mmHg. In the majority of patients no secondary cause will be elicited, but recent data have described a higher prevalence of secondary causes in hypertensive patients than previously suspected. A review of secondary causes (hyperparathyropdism, Cushing's, phaeochromacytoma, acromegaly, hyperaldosteronism, thyrotoxicosis, and renal artery stenosis) will be undertaken including investigations and outcome. Renal artery stenosis and primary aldosteronism pose a particular problem in the diabetic hypertensive population. Controversial issues in management of hypertension in diabetic subjects will be outlined including: 1) Are investigations for secondary causes worthwhile? 2) Role of home and ambulatory blood pressure monitoring? 3) Can we ignore diastolic pressure? 4) Blood pressure target achievement? 5) Choice of anti-hypertensive agent – ACE inhibition always? - adoption of the polypill? 6) Trial data still needed?

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